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Important Terms To Know

To begin you'll need to know a few terms common to the medical industry. While there are enough terms to learn to fill a thick book, these are a few that will help you along the way:

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  • The company that runs your plan

    The company that runs your health plan and determines your benefits

  • Types of companies that could run your plan

    A company that administers a medical benefit plan and pays claims. If you have a TPA, they are probably your benefit administrator.

    A company who collects premiums from its members and pays claims from this pool of money. This is the traditional insurance model. If you have an insurance company, you should contact them with benefit questions.

  • Your network

    A network of providers (doctors, dentists, etc.) who would be considered in-network. You can always see whoever you want, but there may be additional expense if you see an out-of-network healthcare professional. America's PPO is a PPO (as you probably could tell by our name).

  • And a few good things to know

    Someone who provides health care. This could include doctors, chiropractors, dentists, or just about anyone else who treats you.

    Reviewing proposed medical/surgical treatment, procedures or hospital admission for medical necessity before you go in. It's always good to check with your benefit administrator to see if your visit needs pre certification to get full coverage.

    The form you receive that shows how your medical benefits were applied to your claim. This is not your bill; it tells you how much you should owe. The EOB is sent by your health plan administrator, TPA or insurance company.